Impact of Preprocedural Computed Tomography on Left Atrial Appendage Closure Success: A Swiss-Apero Trial Subanalysis.

Galea, Roberto; Aminian, Adel; Meneveau, Nicolas; De Marco, Federico; Heg, Dik; Anselme, Frederic; Gräni, Christoph; Huber, Adrian T; Teiger, Emmanuel; Iriart, Xavier; Franzone, Anna; Vranckx, Pascal; Fischer, Urs; Pedrazzini, Giovanni; Bedogni, Francesco; Valgimigli, Marco; Räber, Lorenz (2023). Impact of Preprocedural Computed Tomography on Left Atrial Appendage Closure Success: A Swiss-Apero Trial Subanalysis. JACC. Cardiovascular Interventions, 16(11), pp. 1332-1343. Elsevier 10.1016/j.jcin.2023.02.027

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BACKGROUND

The benefit related to the use of preprocedural computed tomography angiography (CCTA) on top of periprocedural echocardiography to plan percutaneous left atrial appendage closure (LAAC) procedures is still unclear.

OBJECTIVES

The authors sought to evaluate the impact of preprocedural CCTA on LAAC procedural success.

METHODS

In the investigator-initiated SWISS-APERO (Comparison of Amplatzer Amulet and Watchman Device in Patients Undergoing Left Atrial Appendage Closure) trial, patients undergoing echocardiography-guided LAAC were randomly assigned to receive the Amulet (Abbott) or Watchman 2.5/FLX (Boston Scientific) device across 8 European centers. According to the study protocol ongoing at the time of the procedure, the first operators had (CCTA unblinded group) or did not have (CCTA blinded group) access to preprocedural CCTA images. In this post hoc analysis, we compared blinded vs unblinded procedures in terms of procedural success defined as complete left atrial appendage occlusion as evaluated at the end of LAAC (short-term) or at the 45-day follow-up (long-term) without procedural-related complications.

RESULTS

Among 219 LAACs preceded by CCTA, 92 (42.1%) and 127 (57.9%) were assigned to the CCTA unblinded and blinded group, respectively. After adjusting for confounders, operator unblinding to preprocedural CCTA remained associated with a higher rate of short-term procedural success (93.5% vs 81.1%; P = 0.009; adjusted OR: 2.76; 95% CI: 1.05-7.29; P = 0.040) and long-term procedural success (83.7% vs 72.4%; P = 0.050; adjusted OR: 2.12; 95% CI: 1.03-4.35; P = 0.041).

CONCLUSIONS

In a prospective multicenter cohort of clinically indicated echocardiography-guided LAACs, unblinding of the first operators to preprocedural CCTA images was independently associated with a higher rate of both short- and long-term procedural success. Further studies are needed to better evaluate the impact of preprocedural CCTA on clinical outcomes.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)

UniBE Contributor:

Galea, Roberto, Heg, Dierik Hans, Gräni, Christoph, Huber, Adrian Thomas, Fischer, Urs Martin, Valgimigli, Marco, Räber, Lorenz

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1876-7605

Publisher:

Elsevier

Language:

English

Submitter:

Pubmed Import

Date Deposited:

15 Jun 2023 10:03

Last Modified:

20 Feb 2024 14:15

Publisher DOI:

10.1016/j.jcin.2023.02.027

PubMed ID:

37316145

Uncontrolled Keywords:

computed tomography angiography left atrial appendage closure procedural safety procedural success

BORIS DOI:

10.48350/183432

URI:

https://boris.unibe.ch/id/eprint/183432

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